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Norovirus_MamaCs10_11_17.pptxSprinkles, Anyone?
A Norovirus Outbreak in Lucas County, Ohio
Overview
Local Public Health Epidemiology
Outbreak Investigation
Timeline of Events
Descriptive Statistics
Lessons Learned
Closing Remarks
Epidemiology in Public Health
Disease Reporting
Monitors trends and outbreaks of disease symptoms and confirmed diseases in Lucas County
Follow up investigations
Education to community-opportunity to reduce illness
Ohio Administrative Code
Reportable Diseases in Ohio
http://www.odh.ohio.gov/reportablediseases
Reportable Diseases in Ohio
Reportable Diseases in Ohio
http://www.odh.ohio.gov/reportablediseases
Outbreak
A sudden rise in the incidence of a disease (Merriam-Webster)
Occurrence of cases of disease in excess of what would normally be expected in a defined community, geographical area or season (World Health Organization)
Means the occurrence of cases of disease in numbers greater than expected in a particular population or for a particular period of time (ORC 3701-3)
For Class A diseases, “outbreak” usually means 1 case
For others, it is jurisdictionally-dependent
After Hours Disease Reporting
August 7, 2017 (Monday)
12:26 am—Received call through Engage Toledo
August 7, 2017
August 7, 2017
Epi Investigation
8:00 am– Updated epidemiologists of situation, began making contact with hospital to identify patients seen in ER
Citizen calls started coming in regarding illness
Food Facility Investigation
8:00 am– Food Sanitarian began follow up with food facility
August 7, 2017
Epi Investigation
Family of 6
Family of 2
Noro +
August 7, 2017
Epi Investigation
Contacted ODH, received outbreak number
Numbers of self-reported ill individuals continued to climb
By close of business, reported 34 ill
Food Facility Investigation
Food Sanitarian obtained remaining doughnuts from facility
40 lb bag of doughnuts from July 26-August 4
20 lb bag of doughnuts from August 4-6
August 8, 2017 (Tuesday)
Epi Investigation
Continued to make calls and develop line listing– no apparent pattern or trend
Daily update to Infection Preventionists
Daily update to Region
By close of business, reported 96 ill
Shipped doughnut sample (20#) to ODH
Food Facility Investigation
Met with owners of restaurant, encouraged voluntary closure of facility for deep cleaning
Became aware of doughnut wholesaling– major concern
Also made aware of customers potentially freezing doughnuts…
…and donut cakes
August 8, 2017
August 8, 2017
August 8, 2017
August 8, 2017
http://www.lucascountyhealth.com/community-health/infectious-disease-epidemiology/
August 8, 2017
Wholesale Accounts
St V's (7 days a week)
UTMC Dana Center and Orthopedics (5 days a week)
St. Luke's (Mondays and Wednesdays)
Sunoco on Broadway (7 days a week)
Grounds for Thought (7 days a week)
Marathon on Dixie Highway (7 days a week)- 2 dozen
Hampton Inn on Reynolds (Mon, Wed, Fri, Sun)
Spartan Chemical (Wednesday)
Monclova Road Baptist Church (Sunday)
Calvary Assembly (Sunday)
First Presbyterian in Maumee (Sunday)
St. Joan of Arc (Sunday)
August 9, 2017 (Wednesday)
Epi Investigation
Continued to make calls and develop line listing
Daily update to Infection Preventionists
Daily update to Region
By close of business, reported 214 ill
Food Facility Investigation
Concern for Delivery on 8/9
Revoked Facility License
Recommended professional cleaning service
August 9, 2017
August 10, 2017 (Thursday)
Epi Investigation
Continued to make calls and develop line listing– Surge Epis and Food Sanitarians were called in due to volume of calls (associated with press release and the media)
Daily update to Infection Preventionists + Region
By close of business, reported 266 ill
Food Facility Investigation
Deep Cleaning of Facility using J & R Contracting Co in Waterville, Ohio
Met with Contractors and went over plan for cleaning
HALT®
Sani-T 10®
August 10, 2017
August 10, 2017
August 10, 2017
Quick view of a form utilized by Epis (in Epi Info). This form was also sent to other health jurisdictions who may have had cases, such as Wood County
August 11, 2017 (Friday)
Epi Investigation
Continue interviews
Started receiving reports of secondary cases
By close of business, reported 337 ill
Food Facility Investigation
Walked through facility after cleaning complete
Facility able to re-open
August 11, 2017
August 14, 2017 (Monday)
Epi Investigation
Received results from ODH
By close of business, reported 414 ill (primary and secondary)
Food Facility Investigation
Facility opened for business morning of 8/14
St. Luke’s used their UV Robot at the facility after facility closed
August 14, 2017
August 14, 2017
August 14, 2017
Analysis primary cases
Impacted Counties:
Lucas County, Ohio
Wood County, Ohio
Henry County, Ohio
Sandusky County, Ohio
Fulton County, Ohio
Montgomery County, Ohio
Franklin County, Ohio
Ottawa County, Ohio
Monroe County, Michigan
Huron County, Michigan
Wayne County, Michigan
Impacted States (County Not Available)
Indiana
Massachusetts
New York
Missouri
Kansas
Analysis primary cases
Total primary cases ill: 381 reported
Primary case: All those whose illness was directly associated with consuming a donut made at Mama C’s
EpiCurve Primary Cases N=376
42950 42951 42952 42953 42954 42955 42956 0 1 12 200 113 40 10
Onsate Date of Illness
Primary Case Count
Analysis primary cases
Age Distribution of Primary Cases N=360
Infant (0-2) Preschool (3-5) Child (6-12) Adolescent (13-17) Adult (18-64) Older Adult ( > 65) Unknown 2.3622047244094488E-2 6.5616797900262466E-2 0.14698162729658792 7.874015748031496E-2 0.56692913385826771 6.2992125984251968E-2 5.5118110236220472E-2
Analysis primary cases
Sex Distribution of Primary Cases N=381
Male Female 0.45931758530183725 0.54068241469816269
Analysis primary cases
Symptoms Reported of Primary Cases
N=379
Gas SOB Bloat Loss of Appetite Headache Nausea Vomiting Diarrhea Ab Cramps Fever Dizzyness Muscle Aches Lethargic/Fatigue Chills 2.6385224274406332E-3 2.6385224274406332E-3 1.0554089709762533E-2 5.2770448548812663E-3 0.12137203166226913 0.24538258575197888 0.85224274406332456 0.72559366754617416 0.22163588390501318 0.18205804749340371 1.3192612137203167E-2 0.13984168865435356 6.0686015831134567E-2 0.21372031662269128
Secondary Cases
Secondary Case: All individuals whose illness was acquired by a primary case. Usually close contacts; family members, friends, colleagues.
Secondary cases: 50 reported
EpiCurve of Secondary Cases N=50
42953 42954 42955 42956 42957 42958 42959 42960 42961 42962 42963 1 0 12 15 6 5 4 1 1 4 1
Illness Onset Date
Count
Secondary Cases
Age Distribution of Secondary Cases N=50
Infant (0-2) Preschool (3-5) Child (6-12) Adolescent (13-17) Adult (18-64) Older Adult ( > 65) Unknown 0.04 0.02 0.12 0.1 0.62 0.08 0.02
Sex Distribution of Secondary Cases N=50
F M 26 24
Secondary Cases
Secondary Cases Symptoms Reported N=47
Bloat Headache Nausea Vomiting Diarrhea Ab Cramps Fever Dizzyness Muscle Aches Lethargic/Fatigue Chills 2.1276595744680851E-2 0.14893617021276595 0.31914893617021278 0.68085106382978722 0.74468085106382975 0.42553191489361702 0.2978723404255319 2.1276595744680851E-2 0.1702127659574468 8.5106382978723402E-2 8.5106382978723402E-2
Education, Education, Education!
Education to prevent secondary cases
Education to food facility
It also was a learning experience for TLCHD
